MAUDE MDR 4747478

MDR report key
4747478
Report number
3003964343-2015-00002
Event key
0
Event type
3
Date of event
2013-08-09
Date received
2015-05-01
Adverse event
3
Product problem
3
Patients in event
0
Reporter occupation
0
Health professional
3
Initial report to FDA
3
Event location
0

Manufacturer Contact#

Contact
DONNA SOWERS
Address
19300 GERMANTOWN RD GERMANTOWN MD 20874 US
Phone
240-240-2406
Report source
M
Manufacturer link flag
Y

Devices#

Seq, Brand, Generic table
SeqBrandGenericManufacturerProduct codeModelCatalogLotPMA510(k)ImplantEvaluatedAvailability
1QUANTIFERON TB GOLDNONECELLESTIS ILIMITEDNCDR N

Patients#

Sequence, Received, Treatment table
SequenceReceivedTreatmentOutcome
12015-05-0101. O

Event Narratives#

D

Patient 1

THE PATIENT'S ATTORNEY CLAIMS THAT THE PATIENT ((B)(6)) WAS TESTED AND FOUND TO BE (B)(6) FOR (B)(6) BASED ON THE USE OF A CELLESTIS QUANTIFERON (B)(4) TEST. THE ASSUMPTION IS THE TEST WAS PERFORMED ON A LOT OF (B)(4) TUBES WHICH WERE RECALLED BY THE FIRM (REF 3003964343-01/28/13-001-R). (B)(6) BEGAN TREATMENT WHICH INCLUDED A BATTERY OF PRESCRIPTIONS WHICH ALLEGEDLY CAUSED SEVERE SIDE EFFECTS BUT ALSO INTERFERED WITH HER CURRENT PRESCRIPTIONS. (B)(6) WAS NOTIFIED OF THE RECALL (B)(6) 2012. IT IS NOT CLEAR IF (B)(6) WAS RETESTED. THE PATIENT'S ATTORNEY CLAIMS THAT (B)(6) SUFFERED SEVERE PHYSICAL AND MENTAL PAIN AND SUFFERING, INCONVENIENCE, EMBARRASSMENT, MEDICAL EXPENSES, LOSS OF INCOME AND LOSS OF SOCIETY.

N

Patient 1

AS A RESULT OF A CAPA INVESTIGATION, PAST LEGAL COMMUNICATION WAS FOUND THAT WAS IDENTIFIED AS REQUIRING A MEDWATCH REPORT. THE COMPANY HAS DECIDED TO SUBMIT THIS MDR FOR INFORMATION PURPOSES IN AN ABUNDANCE OF CAUTION AND TO ENSURE FULL COMPLIANCE WITH 21 CFR PART 803. BASED UPON THE INTENDED USE OF THE PRODUCT, IF A (B)(6) RESULT IS OBTAINED, THE PHYSICIAN IS ADVISED TO REPEAT THE TEST FOR CONFIRMATION, AND IN GENERAL THE RESULTS OF THE SCREENING TEST ARE TO BE TAKEN INTO CONSIDERATION WITH THE PATIENT'S EPIDEMIOLOGICAL HISTORY, CURRENT MEDICAL STATUS AND RESULTS OF OTHER DIAGNOSTIC EVALUATIONS. THE ALLEGED PROBLEMS REPORTED ARE THE OUTCOME OF DIAGNOSIS, AND SUBSEQUENT TREATMENT. CELLESTIS FILED NOTIFICATION OF THEIR VOLUNTARY RECALL THROUGH THE REGIONAL FDA DISTRICT RECALL OFFICE ON (B)(4) 2012. CLOSURE OF THE RECALL BY THE FDA WAS RECEIVED (B)(4) 2013